Category: Health

In December, SaskForward began an online public consultation process that asked people across the province to answer the question, “What ‘transformational change’ would you introduce to make Saskatchewan a happier, healthier, and more prosperous place for all?”

After receiving over one hundred submissions from individuals and organizations and hosting a policy summit and discussion with over 120 participants, SaskForward releases Saskatchewan Speaks: Policy Recommendations for Transformational Change. This report puts forward a series of policy recommendations based on the ideas and suggestions Saskatchewan people shared with us.

Three key messages emerged from the ideas shared with us during the consultation process. The first is that public spending that addresses the root causes of social problems needs to be viewed as an investment that will save us money in the long run. While cuts to social spending may improve balance sheets in the short-term, they will create long-lasting health and social impacts that outweigh any initial cost-saving. Indeed, there was widespread consensus that social program cuts – even in spite of the current deficit – were ill-advised and counter-productive to the overall health of the province.

The second message that emerged from the submissions was that respondents want to see much more emphasis on new revenue streams and sources. Saskatchewan’s revenues as a share of GDP have declined from 22.4 percent in 2007 to 17 percent in 2015. Respondents were unified in their call for the government to consider new revenue sources, with a strong preference for increased progressivity in the provincial income tax system.

Lastly, there was a real appetite for a grand vision for the province, particularly in regards to energy and the environment. Many respondents believe that Saskatchewan – with its ample renewable resources and provincial crown corporations – is uniquely situated to take advantage of the nascent green energy economy given the appropriate direction and investment by the provincial government.

Despite the province’s current economic woes, there was a tremendous optimism in the ability of the province to become a more just and sustainable place in the future. We want to thank the people of Saskatchewan for sharing their visions for the province with SaskForward. We certainly hope the government and the rest of the Saskatchewan public will seriously consider the thoughtful and inspiring ideas we have collected in this report.

Family Physician Dr. Sally Mahood suggests how evidence-based policy-making can improve the fairness and equity of our public health system in Saskatchewan.

Social Determinants of Health

Canada is one of the top four per capita healthcare spenders among 17 peer nations but among the bottom four for key measures of health status

The top 1% of income earners (this includes physicians) own 43% of all financial wealth and the bottom 50% own less than 1%

In 2014 Canada spent 11% of GDP on healthcare (up from 7% in 1970’s) and health budgets average about 40% of government expenditures.( This is a combination of increased spending but also decreased revenue generation/tax cuts)

Dollars are skewed heavily towards acute or illness care (29.5% to hospitals, 15.7% to drugs, and 15.5% to physician services)

50% of health outcomes can be attributed to social determinants of health (15% due to biology, 25% to healthcare access), and the top social determinants are income, food security, and housing

In Saskatoon the poorest neighborhoods have 13 times higher incidence of Diabetes, 16 times higher suicide rates and 4 times higher infant mortality (and a similar income gradient exists for most health indices)

50% of $200 billion spent on healthcare annually is associated with the 20% of Canadians with the lowest income

Higher income bracket Canadians live on average 20 years longer than lowest income bracket Canadians

Household food insecurity is a robust predictor of health care utilization and health costs (independent of other social determinants of health)

$1 spent on Housing is estimated to save $11 in healthcare costs

Canada has the weakest public funding for early childhood development among wealthy countries yet early childhood interventions net a $6 return for every dollar invested

By age 80, 30% of seniors are institutionalized and by age 90 almost 50%, yet most people want to stay at home

One third to one half of a person’s healthcare expenditures will happen during the final year of their life

Healthcare Utilization

Rising health care costs are due to many factors (7% due to population growth, 14% to an aging population, 19% to inflation, and 59% to increased utilization)

They are cooks, cleaners, wait staff. They are welders, electricians, and construction workers. They are nurses, physicians, and live-in caregivers. They are manual labourers in greenhouses and throughout the agricultural sector. Residents of Saskatchewan have direct and indirect encounters with them on a daily basis, whether it is each time they order a double-double, access health care, or purchase some locally grown produce.

They are migrant workers: thousands of foreign workers who are in this province on temporary work permits. They are legally allowed to work here, but there are no guarantees that they will be allowed to stay.

The number of Temporary Foreign Workers in Saskatchewan has increased by 310 percent since 2005, yet there is little systematic understanding of their actual experience of work and residency in Saskatchewan. In 2014, there was an estimated 11,000 TFWs in the province (Citizenship and Immigration Canada, 2014). If we include permanent residents and workers employed in the province through company transfers or the International Labour Mobility program, the number of newcomers and foreign workers is at least double.

Why are workers from all corners of the globe coming here to Saskatchewan to work jobs that are often low-wage and lack security?

These workers are just part of an estimated 232 million migrants worldwide crossing international borders in order to find work pushed by the rapid pace of economic globalization that has resulted in high unemployment and increasing poverty in their home countries (International Labour Organization, 2016). These conditions have resulted in a demand for foreign workers in low and high-skilled occupations here in developed economies, like Saskatchewan. The end result as Choudry and Smith (2016) describe it: “with Economic restructuring, labour market deregulation and the erosion of union power, increasing numbers of workers – and especially immigrant and temporary migrant workers – have suffered disproportionality from low-wage employment and welfare state retrenchment.”

Our two, linked research teams are attempting to better understand this population’s health needs, employment conditions, and housing situations. We are studying the issues migrant workers encounter on the job, whether it is about workplace safety or the complex relationship they have with unions. It is critical that researchers, service providers, policy makers and, most importantly, the general public learn more about migrant workers who are making positive contributions to our communities and our workplaces.

Throughout North America, migrant workers are recognized as especially vulnerable to factors affecting health such as poor housing conditions, workplace safety, and access to health services (Preibisch & Hennebry, 2011; Preibisch & Otero, 2014) – all which can be considered modifiable determinants of health, and all of which are affected by various forms of legislation and regulation. It’s also been well-documented that the legal status of migrant workers makes them particularly vulnerable to workplace exploitation and abuse (Faraday 2014; Faraday 2012; Auditor General of Canada 2009). We are comparing the migrant worker realities in Saskatchewan to experiences in other provinces.

This research also seeks to understand the relationship between migrant workers and their respective unions. Although a substantial number of TFWs are employed in industries, like food services and accommodations, with low union density rates, many work in occupations like healthcare and construction where labour organizations have a significant presence (Stevens 2014a). This component of the project also investigates the interaction between migrant workers and employment standards, and how they navigate the existing complaints-based system governing hours of work, minimum wages, and other basic workplace rights.

Method

In order to get a clearer picture of migrant worker life and health-affecting circumstances in Saskatchewan, the first phase of our study reached out to a variety of community partners who work directly with migrant workers. Our Community Advisory Panel (CAP) draws on a wealth of experience and knowledge amongst professionals and community leaders who interact with migrant workers and migrant worker issues. The purpose of the CAP is to help identify stakeholders we could interview and recruit participants for our study. In total 15 key informants were identified and interviewed in 2016. Collectively our interviewees represent a broad spectrum consisting of faith groups, settlement agencies, employers, government regulators, and workplace safety organizations.

Findings

Our preliminary findings shed light on the various ways provincial legislation and regulations affect the well-being of migrant workers. Through the interviews we identified gaps in the established systems (provincial and federal) that are designed to protect the health of these foreign workers. Drawing on and reflecting on our research, questions surface about the design and effectiveness of the provincial mechanisms, particularly related to enforcement provisions, that are supposed to protect migrant workers in Saskatchewan in the areas of employment standards, housing, occupational safety, and accessing health care services.

Accessing Health Care

Our interviews reveal that even if migrant workers are entitled to health care, they have difficulty accessing healthcare services due to language barriers or because they might lack the knowledge of how to navigate the provincial health care system. What is also apparent is that migrant workers are hesitant to report illness and or seek medical attention because they are fearful doing so may compromise their employment and result, ultimately, in deportation. Unfortunately, this fear is not unfounded. The service providers and migrant worker advocates we spoke to provided accounts of this actually occurring:

I know one guy who had his appendix removed, after he was released from the hospital shortly he was sent back home because his recuperation would take longer. So the employer don’t want to risk it because the reality is it’s money that they are investing and they need to get some return so they don’t want to have workers that aren’t healthy or they don’t work. (migrant worker advocate)

These health care realities have even changed the human resource practices in companies that came to rely on the Temporary Foreign Work Program.

We actually partnered with a doctor’s office. And in the doctor’s office there’s like a doctor, a chiropractor, a massage therapist – you know there’s whole bunch of different practices all practicing in one practice. And so for a lot of our people they don’t have a doctor, right? Like they don’t have somebody that they’ve seen ever since they were born. Like a lot of them, when you’re new to the country, you haven’t had that exposure to somebody that may not have just been a walk-in clinic. You know like if you weren’t feeling good. So we never force anybody to go to our doctor, it is always up to them. And the doctors that we work with are very familiar with our processes and that – we want to accommodate. (human resource manager)

Housing

Housing surfaced as an issue among migrant workers according to settlement workers and migrant worker advocates in the community. This includes migrant workers who are free to secure their own housing as well as those who live in accommodation provided by their employers. Access to affordable and safe housing in close proximity to services and sources of employment is limited, especially in Saskatchewan’s two main urban centres. Many interview participants mentioned that affordable housing was often restricted to what they perceive as unsafe neighbourhoods or in poorly maintained properties. It is important to recognize that this is a problem facing many low-income residents in Saskatchewan, and sheds light on the limitations of existing municipal and provincial housing strategies.

Many critical questions surface when examining the effectiveness of the regulatory bodies that are tasked with conducting housing inspections for employers who hire and house migrant workers. Interview participants frequently summoned examples of over-crowding, housing supplied with insufficient number of appliances, and infrastructure that is in poor to inoperable condition. Employers often approached Regional Health Authorities for housing inspection documentation, which they can later submit as part of their application to hire foreign temporary workers:

We would report only on the conditions that we would see the time and the day of the inspection. Which means if they ask for the inspection in the middle of December, and everything is frozen and boarded up because they aren’t going to have [the workers] until summer, all we would say is, this is the time we were here and this is what we saw.

Often time the inspection is before the migrant worker actually shows up because it is part of the approval process to actually get them on site. So often times they are not even there when I am inspecting. (housing inspector)

This reflection is problematic because it does not assure the housing adequately meet the needs of the migrant workers, and sheds light on the limitations of the inspection regime as applied to housing for TFWs. It is also not an accurate assessment of the actual living conditions of the migrant workers once they actually arrive, and fails to prevent the examples of over-crowding summoned during interviews.

Occupational Health

Occupational health encompasses the physical and psychological well-being of workers. Saskatchewan has one of the highest work-related injury rates and the highest workplace injury-related fatality rate among Canadian provinces (AWCBC, 2016). Common occupational health issues cited by our interviewees include migrant workers being over-worked, not being trained properly in workplace safety, lack of proper safety equipment, and/or unsafe working conditions. As one interviewee noted:

Vulnerable workers will often overlook safety, just to keep their job. They’ll often overlook any safety concerns, and that’s the same with migrant workers, or with new Canadians is [that] safety isn’t important. They’ll do whatever they have to do or are told to do and that’ll be it. (union representative)

The consensus among interviewees was that there are significant obstacles to migrant workers reporting workplace injuries, and materials related to OHS rights and responsibilities and OHS training need to be translated into different languages. A key informant had this to say:

Their own situation isn’t stable yet in Canada. They worry that if they complain, there’ll be retribution. And in some cases they come from a country where there was retribution if they were injured at work. Not in all cases but in some cases. So that is the number one thing; the tendency is to not report at all; they’re too scared to report. (member of provincial safety association)

These gaps result in unreported injuries, and migrant workers not getting the support they are entitled to from the Saskatchewan Workers’ Compensation Board. Furthermore, because of injury under reporting, safety associations, the Ministry of Labour Relations and Workplace Safety, and other injury prevention partners, may not have an accurate picture of the types and frequency of injuries experienced by migrant workers.

Labour Rights

Employment standards and labour relations legislation in Saskatchewan has always been a politically charged issue. In the last decade, major legislative overhauls resulted in the introduction of the Saskatchewan Employment Act, which, by some accounts, has tilted the balance of power in the favour of employers and businesses in the province (Stevens 2014b). However, some improvements to the basic floor of employment rights have been established, not least of which is legislation focused on protecting migrant and immigrant worker rights. Some of these legislative changes surfaced in response to hundreds of reported cases of abuse and exploitation.

Interviewees discussed at length the ways in which the precariousness of status makes migrant workers more vulnerable than their Canadian counterparts. The combination of possible workplace exploitation, mistreatment and abuse combined with a lack of understanding about rights in general is identified as a major issue:

The stories I’ve heard from my clients they’re – they were treated very, very badly. They were called even slaves. You came to Canada because I give you these option. I wanted you to come to – and you have to do whatever I tell you otherwise I just kick you as from this place. (settlement worker)

Proclaimed in 2013, Saskatchewan’s Foreign Worker Immigration Rights and Services Act (FWRISA) is designed to police recruiters, immigration consultants and employers, and offer migrant workers legal avenues through which to address instances of harassment and exploitation in the workplace. The province describes this legislation as the most comprehensive of its kind in Canada. In fact, our province’s legislated protections for migrant workers have been given a B+ by the Canadian Council for Refugees in that organization’s 2015 national Report Card (CCR 2015). However, there is room for improvement. Our findings suggest that the legislation does not go far enough in auditing employers, or providing migrant workers with adequate assurances that they will not lose employment or be deported should they choose to file a complaint.

Although FWRISA can conduct investigations regarding abuse or mistreatment of workers, there are only three Integrity Officers plus an Executive Director who are responsible for the entire province of Saskatchewan. This shortfall is reflected in the federal management and enforcement of the Temporary Foreign Worker Program. With over a thousand organizations accessing the TFWP, the sheer number of employers who hire migrant workers makes it difficult if not impossible for even a quarter of employers in Saskatchewan to be audited. The question raised here is whether this creates a scenario whereby abuses may routinely occur, go unreported or are underreported. Since FWRISA also operates as a complaint-based system, it means migrant workers themselves who have a workplace issue, or their allies in the community, must contact the FWRISA hotline. Problems with this complaint-based system have long been documented in Saskatchewan and across Canada (Faraday 2014; Leo 2014). As our evidence shows, it is apparent that the fear of dismissal or deportation is a very real one for many of these workers, and therefore, there is great reluctance to report to authorities and instead continue to tolerate a situation with no reprieve or resolution.

There have also been unintended consequences stemming from FWRISA, which have hindered the capacity of public servants to offer assistants to migrant workers. This also ties into the lack of English language competencies amongst some of these newcomers and the lack of multi-lingual information about services.

One of the big limitations is …you know, there’s so many forms. And everybody says “can you help me do this form? Can you help me do this form?” and actually with the provincial legislation, we cannot help them do the form. We can give them the same information that there would be on the website about the form, and about the categories but we can’t say “if I was you I would put this here. Or I would put it like this”. We cannot interpret their information for them. According to the new provincial legislation that came in February of 2014, where you cannot act as if you are an Immigration Consultant. (settlement worker)

Future Directions for Research and Policy

While this paper represents a short summary of our preliminary research findings, and while there are still many unknowns about the experiences of migrant workers in Saskatchewan, our data raises the questions about the self-regulatory and complaints-driven regulatory model of migrant worker rights. The evidence suggests there is a need for greater resources for migrant workers than what already exists, and that there are not sufficient supports exclusively tailored to the unique needs of migrant workers. It also suggests the protective mechanisms in place ought to be strengthened. Going forward, our research team has highlighted the following issues:

In recognizing that many migrant workers originate in non-English speaking countries, all three levels of government need to consider the translation of documents related to accessing public service, employment rights, and occupational health and safety into languages commonly spoken by these newcomers (e.g., Spanish, Hindi, Tagalog, Arabic).

Consideration needs to be given to making publicly accessible the number of cases investigated by the Ministry of the Economy’s Program Integrity Unit, which oversees the FWRISA, as well as the outcome of these investigations and parties involved. Immigration recruiters and agencies that have been banned from practicing in Saskatchewan need to be included on a government-maintained list.

With legislation already in place for housing, employments standards and occupational health/safety, but gaps in enforcement revealed in this research, Saskatchewan needs implementation of a more robust inspection mandate in these areas. Relatedly, this requires an examination of the existing self-regulation and complaints-based models in these respective areas. Proactive approaches (e.g., random audits and inspections) may help identify those employers that regularly flaunt OHS and employment law. Here, cooperation will be required between Ministries and with municipal levels of government.

Recognizing that issues surrounding access to safe affordable housing are similarly faced by thousands of migrant and non-migrants, local municipalities need to be empowered with a provincial affordable housing strategy. The principal focus should be on the two major urban centres, Saskatoon and Regina, where about half of all TFWs are located. Challenges faced by migrant workers in rural areas and smaller municipalities also need to be considered.

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By “Health Wanted: Social Determinants of Health Among Migrant Workers, and “Saskatchewan in the Global Division of Migrant Labor” research teams at the University of Saskatchewan and the University of Regina.

The last seven months – July 2016 – January 2017 – has seen two major oil spills in Saskatchewan. This has prompted important reactions about the safety of pipelines both existing and in development. It has galvanized communities to take action against the pipeline dependence that is destroying environments and clean water sources for many communities.

Shortly after the disastrous Husky spill on the North Saskatchewan River, Canoe Lake Indigenous Environmental activist leader Emil Bell went on a hunger strike demanding accountability from Husky and the Saskatchewan government, and a true record of what happened with the Husky spill.

Emil Bell’s hunger strike lead to various actions against Husky. The Kisiskatchewan Water Alliance Network was formed linking Indigenous and non Indigenous communities in opposition to the damage to critical water sources in Saskatchewan.

Tyrone Tootoosis, spokesperson for the Kisiskatchewan Water Alliance Network said, “water is life, people and communities want to know how to avoid these disastrous spills and who is accountable and responsible for what has happened.

We need to understand that this Husky catastrophe could happen to any body of water and we need citizen oversight on what the oil companies and the governments are doing. Water, the environment, and communities are too precious to have their interests subordinated to the interests of oil companies”, said Tyrone Tootoosis.

Indigenous communities along the Saskatchewan River System which falls within Treaty 6 territory took action.

“Due to the slow response by Husky and lack of transparency during the containment and cleanup process, the James Smith Cree Nation has decided to take its own mitigation measures and conduct its own sampling. They have expressed that their way of life has been impacted by the spill and that contaminants have been found in lake sturgeon spawning grounds. As a Sovereign Nation, we have taken it upon ourselves to take action and clean our river.” -James Smith Cree Nation (www.jamessmithcreenation.com).

Because of the lack of information or analysis coming from Husky and the Wall government an Independent Water Study was carried out in August by E Tech International Hydrologist Richardo Segovia. The study was supported by Idle No More, Public Service Alliance of Canada (Prairie Region) and the Council of Canadians.

Richardo Segovia’s team spent four days travelling the length of the spill along the North Saskatchewan River, speaking with residents, and collecting some sediment samples at strategic locations.

The study questioned the delayed response which resulted in the spilled oil going 500 kilometers downstream to Cumberland Lake contaminating drinking water for communities from North Battleford, Prince Albert, James Smith First Nation, Nipawin. (Months later Husky has given no adequate explanation for a 14 hour delay dealing with the oil spill.)

Richardo Segovia’s work pointed out, “Husky has not been open with technical information during the spill response. Despite the fact that they have taken thousands of water samples, the public still has not had access to any of the lab results. Instead, residents have had to trust Husky’s own summaries of exceedances of allowable contaminant limits and cleanup efforts. They have not taken any samples beyond Prince Albert, about 375 km downstream, even though contamination has been reported more than 500 km downstream.”

The Independent Water Study also states, “one major flaw in Husky’s sampling program is that they are only analyzing water. The separation of diluted crude into its lighter and heavier components causes some of the contaminants to end up attached to suspended river sediments and deposited on the river bottom, especially as time goes on. Husky is missing a major part of the contamination in not sampling sediments and could be leaving behind a toxic legacy for years to come.”

In a public statement E-Tech hydrogeologist Ricardo Segovia, warned that the hydrocarbons detected in sediment along the river are “very, very nasty” and could persist for years. He says, “You can’t go back to the way things were before … because there’s that chance that (contaminants) can be stirred up from the sediments, you have to be constantly monitoring those water intakes for the next several years at least.”

Although this study was conducted last summer it leaves some disturbing questions such as the long term effect of the oil in the sediment, how far the oil has travelled down the Saskatchewan River, and the release of hydro carbons from the spill affecting wild life and human communities.

On September 18th the Kisiskatchewan Water Alliance Network organized a Rally for Water in Saskatoon that had hundreds in attendance. Guest speakers included David Suzuki, Water for Life leader Christi Belcourt, Derek Nepinak, Grand Chief of the Manitoba Assembly of Chiefs, Ricardo Segovia.

Demands made at the Rally for Water included:

Respect and adhere to rights and obligations of water use and flow on Indigenous lands and territories.

Conduct a public Independent Inquiry into the Husky oil disaster.

Do an Independent Audit on the real costs of the Husky Disaster – now and future costs.

Establish an arms length independent watch dog to monitor and report on the safety to the public of oil pipe lines, oil wells and fracking in Saskatchewan.

Demand that the government of Saskatchewan introduce the strongest environmental safety regulations and regulatory power over the extraction and movement of resources such as oil.

Support and encourage the abilities and resources of communities to do their own assessments of water quality and preserving clean water sources.

Build alliances for safe, clean water and water preservation community to community.

Turn Saskatchewan from a petro-state to one of renewable energy use.

Subsequent to these calls for action the Saskatchewan Environmental Society (SES) in December 2016 called for an independent third party investigation that would take the form of a public inquiry. It would look at the actions of Husky and the provincial government as well as the broad environmental implications of the spill and its effects on local communities and First Nations. SES also called on the provincial government for more stringent safeguards, including environmental oversight, better inspection and emergency protocols, and more modern spill detection equipment.

In this same month the Wall government refused the request of the Privacy Commissioner for information on five years of pipeline inspections.

In January 2017 the next great oil spill took place of 200,000 litres on the Ocean Man First Nation Land. Undetected for days from a 49 year old pipe line that had never been inspected, and only discovered by a smell. The government was extremely slow in making it public – a three day delay.

With the planned announcement of moving the Enbridge Line 3 across southern Saskatchewan these spills and cover ups by oil companies and the provincial government show how threatening the pipelines will be to communities and the environment.

Kisiskatchewan Water Alliance Network has called for intervention from outside this province for a probe on the oil spills and most importantly how communities can be defended. An alliance – inside and outside of Saskatchewan – demanding to know what has happened and will happen in Saskatchewan will be critical in withstanding the heavy pressure for pipelines across Canada. Such an alliance would have its base water for life and link Indigenous and non Indigenous communities and would be a strong potent for resistance and change to a non fossil fuel based economy and society.

We have heard that Saskatchewan has a financial deficit of about $1 billion. We know that a large proportion of our Saskatchewan budget, perhaps 40 percent, is devoted to what is called “health care” although more correctly it should be called illness care and treatment. A significant portion of that cost is what the provincial government pays for treatment of diabetes and other obesity-related illnesses. We also know that prior to 1960, diabetes of type II was relatively rare in Saskatchewan whereas now it is considered an epidemic.

What is called for here is real “transformational change,” not just continuing the current treatment approach, but an upstream approach, a prevention approach, dealing with causes, and gradually reducing treatment costs over time.

In this submission we claim that obesity is preventable, and with it, many obesity-related illnesses, such of diabetes and the complications associated with diabetes. We claim that in our society we presently have the knowledge and skill to prevent obesity but we are not putting a sufficient priority on prevention. We claim that increasing the current health promotion and disease prevention budget to 3 percent from the current 1.4 percent of total health expenditures by Saskatchewan Health would have a major impact in reducing obesity and reducing overall “health care” costs. We suggest that the following claim be pondered, at least briefly, rather than dismissed as outrageous:

“…if all residents of Saskatchewan had healthy weights (BMI = 20 to 24.9) the province would save up to $260 million a year… If all Saskatchewan residents had healthy weights and did not smoke, the province could save up to $570 million a year.” (Colman 2001: 20)

Finally we claim, if we do not increase substantially the current efforts at prevention, that obesity, diabetes and related costs shall continue to climb dramatically, with major negative impacts on all Saskatchewan residents.

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“Widespread increases in physical inactivity and caloric intake have led to a global epidemic of overweight, obesity and diabetes. The reasons for these trends are multifaceted and complex. However, major drivers include the ubiquity of high-calorie, low-cost convenience foods, increased portion sizes, and a way of life that encourages sedentary behaviour, such as sitting at computers, in front of television screens, and in cars” (Booth 2015).

For the first time, in 1997, the World Health Organization (WHO) referred to obesity as a “global epidemic.” For the first time in human history, the number of overweight people in the world now equals the number of underfed people, with 1.1 billion in each group (Colman 2001).

Obesity and diabetes have reached epidemic proportions in Canada. Obesity is a major risk factor for diabetes and many other chronic diseases, all of which place major costs on the health care system and the economy as well as the individual and family involved. For example, obese Canadians are four times more likely to have diabetes than those with healthy weights. Obesity was not a problem several decades ago. Obesity is preventable. A cost-effective strategy must take an “upstream” approach, aiming at prevention of obesity, focussing primarily on adequate physical activity and a healthy diet from an early age and secondarily on the physical environment.

Obesity is a sensitive subject. Our intent here is not to cast blame, to make overweight people feel bad about themselves, or to allow healthy weight people to feel smug. “On the contrary, it is to suggest that Saskatchewan could take the lead in turning around a highly destructive global trend, and to encourage communities, schools, policy makers, health professionals and ordinary individuals to work together to improve the health and well-being of all our citizens” (Colman 2001). Pursuing healthy weights should not be viewed as simply a purely individual responsibility but a challenge calling for a “whole-of-society” approach (Obesity in Canada, Canada Senate Report, 2016:18).

Extent of Obesity and Diabetes

The extent of obesity in Canada is “high and rising:” even more alarming is the recent increase among children and youth. Two-thirds of Canadian adults are overweight (BMI= 25.0 to 29.9) or obese (BMI=>30.0), (where BMI or Body Mass Index = weight in kg/height in cm squared). This has increased dramatically over the past 25 years, roughly doubling in adults. One quarter of Canadian adults and 8.6 percent of children and youth aged 6-17 are obese according to measured height and weight data from 2007-2009 (Obesity in Canada, p. 4). Another source states that in the period 1985 to 2011 obesity tripled from 6 percent to 18 percent of the Canadian population.

Other sources show similar findings: obese Canadians are 20.2 % of the population; overweight and obese men are 62 % and women 46 %. Another source shows that among non-aboriginals, age 18 and over, 2009-2010 data, the percentage who are overweight or obese is 51.9%; among First Nations on-reserve it is 74.4%; among First Nations off-reserve it is 62.5%, 2008-2010 data (Public Health Agency of Canada, 2011).

In Saskatchewan, nearly two-thirds of residents have an unhealthy weight, second only to New Brunswick (Colman 2001). In Saskatchewan, approximately 57 percent of adults and 20 percent of youth are either overweight or obese. Regarding diabetes, it is estimated that the number of people living with diabetes in Saskatchewan will grow to 100,000 in 2017, up from 97,000 in 2016, and will increase by 35 percent in the next decade. In addition, a further 176,000 are expected to be living with pre-diabetes and another 43,000 living with undiagnosed diabetes (Canadian Diabetes Association, 2017??). Not only is the number of people with diabetes growing, but so are the serious complications they experience such as heart attack, stroke, kidney failure, blindness and limb amputation, all of which incur serious costs on the individuals, families and the province.

Impacts

Obesity is a risk factor in many chronic diseases. Obesity significantly increases the risk of Type 2 diabetes, cardiovascular disease, hypertension (high blood pressure), high cholesterol, osteoarthritis and certain types of cancer. In turn, diabetes leads to serious complications as listed above. Estimates of the cost of obesity in Canada range from $4.6 billion to $7.1 billion annually (2006). For diabetes alone the cost in 2000 was $2.5 billion a year (Diabetes in Canada, p. 47).

In Saskatchewan obesity is the second-leading preventable cause of death after cigarette smoking. It is estimated that more than 960 Saskatchewan residents die prematurely each year due to obesity-related illness, compared to 1,200 deaths due to tobacco and about 100 road accident deaths.

Obesity-related illnesses cost the Saskatchewan health care system an estimated $120 million dollars annually, or 7.3% of total direct health care costs. When productivity losses due to obesity, including premature death, absenteeism and disability are added, the total cost of obesity to the Saskatchewan economy was estimated at between $230 million and $260 million a year, equal to 1% of the province’s Gross Domestic Product. If present trends continue, these costs could surpass the direct and indirect costs of tobacco smoking, currently about $311 million a year (Colman 2001).

A recent study indicates that diabetes alone costs Saskatchewan’s health care system $99.8 million a year in direct costs including hospitalization, doctor visits, dialysis and inpatient medications.

Although obesity represents a burden for some, it is a boon to economic growth and the GDP. The obesity epidemic is a boon for the pharmaceutical industry. New factories need to be built to produce more insulin and other anti-diabetic drugs to meet the skyrocketing demand from those with diabetes, as global incidence of diabetes is expected to double to 300 million people by the year 2015. Like war, crime and pollution, illness can make the economy grow more rapidly than peace, health and a clean environment. In the USA, liposuction is the leading form of cosmetic surgery; diet and weight loss industries contribute $33 billion to the U.S. economy annually (Colman 2001: 23).

Causes

Obesity involves a wide and interactive range of behavioural, biological/genetic, and societal factors. Health behaviours or lifestyle factors, primarily eating healthy food and having adequate physical activity, are themselves influenced by deeper societal factors like stress and work patterns.

Poor eating habits (including low consumption of fruits and vegetables and high consumption of refined carbohydrates and sweetened beverages (Bray 2003), particularly high-sugar, high-salt, fast food, show a strong association with the prevalence of obesity. Eating habits, healthy and unhealthy, are learned at an early age, like developing a taste for vegetables or for foods with sugar and salt: much food marketed as baby food has considerable levels of salt and sugar. Access to healthy food also is important: low income and distance from a food store may lead to more use of closer convenience stores with poorer food choices. For those with higher incomes, sedentary lifestyles, longer work hours, rising stress levels, may all contribute to increasing unhealthy weights. In Saskatchewan residents eat out more often than they used to and one quarter experience high levels of chronic stress (Colman 2001).

The food industry contributes $30 billion in advertising to the U.S. GDP (Gross Domestic Product), more than any other industry does, and much of it promotes the very foods that cause obesity: much of it targets children and youth. In Canada, current support for education or information programs aimed at nutritional illiteracy is infinitesimal in comparison: it appears that we are simply leaving this topic to the food industry.

Physical inactivity also has a strong association with obesity for both men and women. In the USA, which does not have universal Medicare, some HMOs (Health Management Organizations), finding that people who are more active use fewer medications, encourage their clients to participate in physical activity by subsidizing gym fees,

Less than half of Saskatchewan residents exercise regularly (three or more times a week), the second lowest rate of activity in Canada, and a quarter either never exercise or exercise less than once a week. Saskatchewan residents watch an average of 3.25 hours of television each day (Colman 2001). Television watching often begins at an early age, followed by video games and smart phones.

Although lifestyle is the major risk factor for obesity, societal factors such as family history, ethnic background and socioeconomic status, as well as the physical environment also play a significant part. Obesity is correlated with low educational level, poverty and rural residence; obesity also is generally higher in Aboriginal (37.8%) than non-Aboriginal people. Climbing obesity rates are less the fault of individuals and more a consequence of changes in the food environment (e.g. a huge increase in fast food outlets) and a decrease in physical activity demands in daily living, resulting in an “obesogenic environment” making it too easy to eat poorly and remain sedentary (Obesity in Canada, Senate Report, 2016:8)

A more recent consideration regarding obesity that is gaining momentum among public health officials, at least in urban areas, is the potential to design or redesign the built environment in which we live—including buildings, parks, transportation systems and overall communities—to promote active, healthy living. Numerous studies have suggested a link between neighbourhood characteristics – including urban design, the presence of recreational spaces and “foodscapes” –and the physical activity and dietary patterns of local residents. Thus there is growing evidence from large, observational studies that neighbourhoods that provide more opportunities for walking and cycling have lower rates of obesity and diabetes. Collectively, this evidence suggests that population interventions targeting the built environment may have long-term health benefits (Booth 2015).

Suggested Interventions

Saskatchewan Ministry of Health

That the Ministry increase the health promotion and disease prevention budget to 3% from the current 1.4% of total health expenditures (currently 98.6% of Saskatchewan’s “health care” budget is actually comprised of illness-treatment expenditures. Currently we spend substantial amounts to make Saskatchewan roads safer and reduce the likelihood of about 100 road accident deaths annually: a fraction of that invested in nutritional literacy and physical education programs might yield significant dividends both in lives saved and in reducing the annual quarter billion dollar drain on the Saskatchewan economy due to obesity-related illness (currently about 960 lives lost yearly).

That the Ministry develop performance indicators that reflect upstream preventative measures as well as downstream treatment measures like wait times.

Promote the use of physician counseling, including the use of prescriptions for exercise.

That public funding be increased for treatment of obese adults and youth: counselling, medication and surgery.

Saskatchewan Ministry of Education: Children and Youth

Mandating and funding school boards to implement the existing policy that children and youth engage in 30 minutes of moderate to vigorous physical activity daily at school. (Inspiring Movement 2010). This is not necessarily the same as

Monitoring to what extent school boards have implemented the 2010 policy on physical activity.

Limiting foods and drinks sold in schools to healthy choices: these should provide healthy meals as well as educational opportunities for children to participate in meal planning and preparation.

Nutritional education.

Other Public Policy

Regulation of marketing to children particularly of the energy-dense, nutrient-poor foods and beverages

Warning labels and taxes on unhealthy foods and beverages (akin to current anti-tobacco strategies)

Community planning that promotes active commuting and recreational physical activities

Financial incentives, similar to the Children’s Fitness Tax Credit, for low income adults and seniors affected with chronic conditions, to attend a fitness centre that provides supervised physical activity.

Dependable funding for programs such as ParticipAction.

General

In view of the correlation between stress, long work hours, poor dietary habits and gains in overweight, consider creating jobs by reducing work hours as European countries have done (Colman 2001)

Questions

How much currently is spent by government and non-governmental organizations like the Canadian Diabetes Association on prevention?

What research has been done on the possible cost-effectiveness of prevention measures such as those suggested here?

Why do Saskatchewan governments of all political stripes continue to spend so little on prevention?

How much could we save in the cost of anti-diabetic medications with a nation-wide pharmacare plan involving bulk purchases?

How much attention is given in Saskatchewan schools to (a) learning healthy eating practices, cooking, and vegetable gardening? (b) physical activity? (c) community alternatives to school bussing?

What lessons have been learned from the reasonably successful anti-smoking campaign in Canada?

Obesity in Canada: A Whole-of-Society Approach for a Healthier Canada. Report of the Standing Senate Committee on Social Affairs, Science and Technology, 2016. Retrieved 2017/01/30, https://sencanada.ca/content/sen/committee/421/SOCI/Reports/2016-02-25_Revised_report_

Diabetes in Canada 2011: Facts and figures from a public health perspective. Public Health Agency of Canada, Ottawa, 2011. http://www.phac-aspc.gc.ca/cd-mc/publications/diabetes-diabete/facts-figures-faits-chiffres-2011

Northern Saskatchewan has a population that is 80% Cree, Dene and Metis. Northern communities maintain a strong relationship with the lands, rivers and lakes of the boreal forest we call home. The lands and water are intrinsically tied to the physical, emotional and spiritual wellbeing of the people.

Since the inception of the colonial institution called Saskatchewan, the Original People have faced trauma through the decimation of the population from diseases introduced by fur traders, the kidnapping, abuse and indoctrination through residential schools, and the continuous theft of lands and resources through the shady legislation, the NRTA (Natural Resources Transfer Act) in 1930. Every single community has been left with intergenerational issues that have not been addressed.

When the government of Canada gave away the lands and resources to the province of Saskatchewan without the agreement or even consultation of the Cree and Dene Treaty partners, they intentionally set up the process to force the Original People of the north to lose their autonomy. This is ongoing, as the Indigenous people are pushed into dependence on the ‘Boom and Bust’ resource extraction economy, which decimates the lands and waters.

The provinces designated the north as ‘Open for Sale’, and northerners whose cultural values of taking care of the land in the best interests of the next seven generations, are becoming ever more stressed, as they see once pristine waters becoming contaminated. Industrial development is scarring the lands, erasing ancestral presence and making some places permanent sacrifice zones.

We are the fastest-growing population in the province. Northerners are intentionally kept on the edge of poverty due to inequitable opportunities and spending rendered on the part of both the provincial and federal governments. Jurisdictional issues further confuse and divide services. Yet, billions of dollars worth of resource commodities are remove from our homelands annually. Forests are literally disappearing down the road, while every northern community has a shortage of adequate housing. We observe how the province has turned a blind eye to corporations like Cameco, which for years has avoided paying billions of dollars in taxes.

The time is long past due for the knowledge of Cree, Dene and Metis land users of the limitations of living systems on their lands, to over rule that of governments. The influx of industrial development and resource extraction is taking a heavy toll. This is having a global impact. These ecosystems contain a great portion of the world’s fresh water. The trees and muskegs are a living part of that. They also provide the key to carbon capture if left intact.

People who live close to the land notice the extreme changes in climate. Indicators from the plant and animal world are no longer able to predict the weather. Eons of traditional science knowledge has been rendered useless by climate change within the last two decades. As climate change progresses, extremes are going to have an increasing impact.

The Saskatchewan government has failed repeatedly to respect the Original People’s knowledge in the consultation process on resource development projects. The government approves exploration and Environment Impact Assessments on Indigenous lands, regardless of and prior to, consent or concern on the impacts this has on the Dene, Cree and Metis land use. When northern people say “No” to these projects, we are looking long term, beyond the economic trade deals. We have a duty to look after land, air and water for the benefit of all future generations.

The federal government has embarked on studying the concept of a Northern Corridor, which would be a several kilometer wide cleared swath running seven thousand kilometers across northern Canada. In Saskatchewan, it is proposed to begin one hundred kilometers north of La Loche in the northwest, through the Athabasca Basin and splitting north towards the Port of Churchill and east to northern Manitoba. It would include a highway, rail line, pipelines, electrical transmission lines and telecommunication lines. The authors of the proposal, the University of Calgary School of Public Policy, claim this would lower the cost of groceries for northern residents. They also claim this would leave the lightest environmental footprint, while cutting the cost of northern development. The Northern Corridor is, in reality, a thinly-veiled plan for cutting the cost for corporations to move the resources they extract from our north to ports to the international markets. It would open the north to exploitation and increase the environmental impacts as more resource extraction would seize the opportunity.

The authors suggest that legislation be enacted to enable the entire project to be subject to only ONE environmental impact assessment, over all jurisdictions nationally to fast track its completion.

Part of the purpose of the Northern Corridor is to free the southern transportation system in the heavily populated south from being put at risk by using the northern route as the Dangerous Goods Route. This corridor would be totally disruptive to a highly sensitive landscape. The prospect of rail cars, vehicle traffic, and pipelines carrying hazardous materials across thousands of rivers, lakes and muskegs is an environmental nightmare in the making, 3 especially with the weak safety records and minimal cleanup response already evident in this province and country.

This is another made in the south project, which has been hinted at by the Saskatchewan Chamber of Commerce, with little to no input from the Indigenous people whose lands are being targeted. This colonial patronizing viewpoint offers little but further exploitation. In order to get around the indisputable truth that the provinces do not own these lands, the policy designers are suggesting that Indigenous peoples be enticed to partner in to the hundred billion dollar project.

Considering all of the issues that have been imposed on Indigenous people, the impacts, both socioeconomic and environmental, would greatly exacerbate the problems.

Indigenous people must have final authority, as actual true stewards, over what development takes place on their lands and waters, and have the authority to regulate it. Northerners need to develop community and regionals plans, and have those plans respected and supported by the province. Corporate interests have no place, and should not be allowed to influence, the current and future Indigenous leaders to override their people’s values, interests and government systems, with corporate governance programs, such as they have at the University of Saskatchewan, in the Cameco-sponsored Aboriginal Governance and Northern Development.

Energy

Our province’s name is Cree, meaning swift-flowing water. Saskatchewan could champion renewable energy by harnessing the abundant kinetic energy of our rivers, the winds, as well as that readily available in our long hours of sunlight.

With the effects of climate change already manifesting themselves worldwide, including in the northern Boreal forests where sparse precipitation has contributed to unprecedented wildfires, maintaining a fossil fuel energy course is both morally and financially irresponsible. It is imperative that all building codes be immediately revised to implement energy efficient designs and practices, such as passive hausing and the use of solar panels.

At the same time, we must denounce the uranium industry’s (and the current provincial government’s) attempt to sell nuclear energy as the “green solution” to the fossil fuel dilemma. Besides contributing significantly to fossil fuel emissions throughout the entire fuel chain, the undeniable fact remains that the byproduct of nuclear energy is, in comparison, by far the most extremely hazardous and long-lasting threat to life on the planet, extending into millions of years.

As is the case with most fuel industries, much of the raw product lies buried in traditional Indigenous lands. Companies including Cenovus and Cameco have targeting vulnerable Aboriginal administrations down to a science, resulting in highly controversial “agreements” for resource extraction signed behind closed doors. By the time the general population finds out, it is too late, and political pressure attempts to silence dissenters.

Indigenous communities worldwide are also being targeted from the other end of the nuclear fuel chain, with the burial of deadly waste product on their traditional territories. The years of “site selection process” imposed by the Nuclear Waste Management Organization on the northern Saskatchewan communities of Pinehouse, English River First Nation and Creighton, served to tear those communities apart as administrations and certain “liaisons” were bribed into pushing the process through. The pain and grief of division left in NWMO’s wake in some cases may never be resolved. The nuclear waste burial was touted to be shallow to allow retrieval and reprocessing of the nuclear fission rods to extract plutonium by dissolving them in acid, creating an even deadlier byproduct. Despite a petition with over 20,000 signatures delivered to the Saskatchewan Legislature in 2012, we are still waiting for a provincial ban on the storage and transportation of nuclear waste in and through Saskatchewan.

We must have a provincial energy policy that serves people as opposed to industry. Elon Musk’s advancing solar battery technology is already precipitating an energy revolution: independence from the electrical grid. In the same way, we must move to community-based energy supply, as opposed to dependence on industry – “energy sovereignty” – if you will. We need policy that weans us off fossil fuels while at the same time creating infrastructure to capture and utilize renewable energies. Mark Bigland Pritchard and Peter Prebble, in their Green Energy Plan, have already written the script for this to happen. We must have an energy policy that prohibits the bribing of vulnerable populations into sacrificing their sacred lands. Ultimately, we need policy that is socially AND environmentally responsible, two things inseparable in the Indigenous way of knowing. It honours and protects the wellbeing of seven generations ahead.

Restoring Well Communities

Since the inception of the colonial institution called Saskatchewan, Indigenous peoples have faced trauma through the decimation of the population from disease, kidnapping, abuse and indoctrination through residential schools, and the theft of lands and resources through the 1930 Natural Resources Transfer Agreement (NRTA) that continues to this day. The result has been intergenerational impact in every northern community, namely ongoing grief and trauma manifesting itself in family dysfunction, addictions, misdiagnosed learning disabilities and widespread mental health issues.

“Indigenous” has recently become a global catchword to describe healing practices founded in earth-based spirituality. We are fortunate to still have people among us who have come about that paradigm honestly, ie directly inheriting the world view, knowledge and skills from their 5 ancestors to genuinely carry it out. However, from an Indigenous viewpoint, every person innately carries this relationship with the earth, as we simply would not exist without the life provided by it. “Wellness” therefore, is something to be restored, not learned from scratch.

There are northern health professionals who have already established successful, trusted working relationships from the bottom up with youth, parents, families, communities and other professionals across the north, in Indigenous healing practices. This essentially means they are local, effective, inclusive and ongoing. They include upstream, proactive measures designed to build positive identity, confidence, dignity and leadership. However, in the present colonialized system, existing policy across a multiplicity of agencies and organizations makes possible the undermining of locally-developed services, as “proven” as they might be. Funding continues to be applied top-down – from the outside in -perpetuating ineffective practices of engagement, diagnosis, unrealistic strategies and lack of continuity. One example is the mailing of referral letters to people whose health conditions have rendered them so vulnerable as to be living on the street, pre-empting the possibility of ever receiving mail, let alone following through to attend a series of 30-minute one-on-one appointments booked in offices several hours away in the city. Yet, the fact that there’s a paper trail referring the individual to a psychiatrist, allows the lie of accountability to continue.

Restoring well communities means that every individual within that community is viewed as valuable, capable and deserving of the best care possible. Although northern Saskatchewan has some of the highest rates of suicide and drug/alcohol addictions in the country, there is not one wellness center. Our population of Elders is increasing dramatically, yet our northern communities have little or no facilities which allow them to maintain quality of life close to their families, while accommodating their higher level health needs. Despite a comprehensive, eight-year study by a northern health board which unequivocally determined the exact infrastructure required within every community on the northwest side to deliver quality health care to local residents, political interference at the eleventh hour resulted in the announcement of a huge hospital to be built in only one of those communities, literally abandoning the rest. That hospital now operates as little more than a holding facility for patients destined to be shipped south, while people and health staff in surrounding communities continue to languish in decades-old, moulding clinics.

On-the-land health practices, by definition, require a healthy land base in which to take place. However, colonial government policies past and present have systematically displaced Indigenous peoples from their land to make way for industry to enter and remove “resources” such as uranium, trees and oil. Traditional territories have been rendered into sacrifice zones where people who populated it for generations become trespassers on their own lands. Locals have referred to the land as their church, and their hospital, yet we are seeing it increasingly mined and clear cut. Industries bribe Aboriginal administrations into signing so-called 6 “agreements” behind closed doors, which are done deals before the population finds out about them. Subsequent “public consultation meetings” are held, while the industry is already hauling the resources off the land. Uranium companies Cameo and Areva are allowed access to youth across the northern school division, conducting aptitude tests in classrooms to determine suitability for work in the mines. Positions underground and in the mill, the most highly radioactive places, are almost entirely held by Aboriginal youth. Mine workers disclose serious safety breaches in private, but refuse to do so publicly for fear of losing their jobs. Health professionals refuse to conduct comprehensive health studies, apparently because we don’t have a sufficient population base. Regulatory bodies such as the Canadian Nuclear Safety Commission apply the ALARA principle – “As Low As Reasonably Achievable”, and phrases such as “less than severe” and “non life-threatening” to minimalize impact. Public information sessions show slideshows of utopian green cartoon trees growing over contaminated sites, while at the same time reports come in from other former mine sites of contaminated groundwater, plants and even muscle and bone tissues of large game animals such as moose and deer. Generations of families suffer from increased cancer rates, with the only explanation given as “smoking”, even though the cancers are not all originated in the lungs. All the above is strategically supported by existing government policies, and serve to seriously undermine control over our own effective healing in the north.

Besides all the aspects of community health, a valuable initiative to re-vitalize would be the Healthy Community networking concept. Health Canada introduced this in the 90’s when the Northern Village of Beauval was offered funding for community development. This included the services of two community development facilitators, training, several community gatherings, funding for a Healthy Community coordinator, and expenses to attend national and international Healthy Community conferences. In cooperation with the local municipal office, the coordinator facilitated networking by community agencies, resulted in many improvements. Regular input from community gatherings surfaced needs for services such as an Addiction centre, Kids First, and Head Start.

National networking involved exchange of information with other communities across the country in the project, mostly rural and aboriginal, and the sharing of inspiring ideas. The International Americas Conference was in Quebec City, and reps from each Healthy Community attended. North and South Americas now exchanged ideas and scenarios, and learned strategies and geography.

This is a specific example how funding can be used toward community development, with far reaching effects. Almost 30 years later, the Northern Village of Beauval still has its Kids First and Head Start school, and continues to hold weekly Interagency meetings, with the intent of 7 building community through sharing information. National and International gatherings of community representatives could also still result in benefits. Truly effective healing must be led by northerners themselves, with both provincial and federal governments in supportive roles, namely funding long term community-based healing programs and removing barriers created by colonial socio-economic policies.

Housing and Infrastructure

In northern Saskatchewan there is a severe shortage of housing, yet we are surrounded by building material and have an abundance of capable young adults in need of a purpose. What could be more purposeful than constructing your own home, which would then have the added bonus of ownership, pride, and dignity that comes along with it.

We need housing policies that allow for communities to set their own standards which address specific needs, instead of being constricted by unrealistic laws and codes. For example, one northern village determined through a comprehensive, bottom-up consultative process, that small (600 square feet) two-bedroom homes with the ability to add on if necessary would be the ideal unit type for their community, which had a large population of young single parents in need of housing.

Another example is, to be totally realistic, the whole concept of house insurance should get tossed out the window. Most low income families, or single young adults can’t afford insurance anyway. If the Saskatchewan Housing Corporation is allowed the option of foregoing insurance for its hundreds of units due to the expense, then shouldn’t individual homeowners be given that same choice?

Rather than logging companies cutting down timber on our traditional territories and hauling it out of our region, the practice of selective logging for local use could be re-implemented. Each community could be supplied with the equipment required to log selectively and mill the lumber into building materials. Local youth would be trained in energy-efficient construction, including the installation of solar panels, and the necessary trades. Four houses could be heated by one outdoor woodstove, the maintenance of which would also create sustainable local employment.

Elders in the community could be cared for in much the same way, with an elders residence also built to be energy efficient and heated with the appropriate number of outdoor woodstoves. Each community should be provided a state-of-the-art medical clinic attached to the elders residence, with the appropriate number of acute care beds. Every community should be provided with the means to administer Level 4 care for its Elders within that community, to allow for ongoing family support.

Assisted living for those with addiction and mental health issues is a must in every community. These would also operate according to local policies.

To improve infrastructure, communities must immediately be given the means to permanently access a clean water supply. Northern communities are regularly subjected to massive power outages, which could be resolved by implementing local energy sources such as solar, wind and water. Policies affecting small business need to change to support success, for example start-up cost and tax breaks. Locally-sourced food such as wild game and fish should be able to be sold and served in local restaurants, without the hindrance of government regulations. In most of our communities, malnutrition and even starvation are too close for comfort. The dependence on food being shipped up to us is a risk we can no longer afford.

Culturally-Valued Education

The present educational system, in special areas, like the foundations, philosophy and axioms, is not strong in the element of learning for life’s sake.

The old and made-irrelevant features of ancient Indigenous world views, based on the pure sciences of interaction with the natural world and its cosmological directive, is hardly a part of the colonial impetus that is today’s meaning of education. The conditioning apparatus of the present system has very little and abiding meaning except for the promotion of a livelihood, which means, the lands/waters destructive companies can have their way, which they have. There is no argument when a very exciting subject matter like nuclear science, bio-tech, and myriad topics, are omitted in classrooms and only “jobs” is being implemented into the learning strategies of curriculum in Native schools.

Whosoever has the control of today’s education, also has the control over a people. True to form, what our parents taught us in the camps,, backed up by ancient premises already developed down the ages, is the mainstay of what a learning is, and to be reinforced if such a colonial dictum is to be destroyed.

Treatise has been developed by genuinely Indigenous educators which will require careful reading, and have also been placed into practicum. Numerous strategies have been applied with success, but not supported by the present education “system”.

Education that is culturally-valued is first and foremost based on respectful relationships. A respectful relationship mutually values the whole person, and recognizes and acts to resolve issues that are keeping someone from being whole, in ways that allow the learner to internalize those ways of retaining and nurturing wholeness.

Culturally-valued education preserves, promotes and celebrates the inherent dignity of all cultures, which means removing the lens of colonialism and bringing the true, entire story into focus. In culturally-valued education, it is recognized that all people, Indigenous or not, are colonialized. Relationships cannot be genuine unless they’re founded in the truth and guided forward from there.

The truth in Saskatchewan is that it was founded in colonialism. The people who were here before European contact were systematically pushed off their lands to make way for the incoming, starved, discriminated against, and forced to release their children into residential schools. The goal was assimilation, to cut off the normal ability of families to pass on generations of wisdom and skills. The result was genocide, and subsequent generations of dysfunction, grief and misery. Culturally valued education recognizes that grief and trauma erode the ability to learn, therefore prioritizes healing over all. This approach naturally accommodates the adult learner, and doesn’t place a limit on age. Culturally-valued education has processes built in place to give voice to local community and be directed by that.

In the last decade, local school boards were replaced by “community school councils” which, although democratically elected, have virtually no say in things such as budget and hiring, disciplining and firing. Policy needs to change back to empowering the community in the education of its youth. Culturally-valued education is not subsidized by industry that has a vested interest in recruiting students into its production. Northern Lights School Division spans the entire northern half of the province. Cameco and Areva are regularly allowed into NLSD gymnasiums to promote uranium mining, and into classrooms to administer aptitude tests measuring students’ suitability for work in the mines. Students are told, sometimes even by teachers and school administrators, that their purpose in graduating is to “get a good job in the mine”. Elders in the school are warned not to discuss nuclear waste with the youth. Career Fairs are paid for and almost entirely represented by uranium corporations. Our education in the north has truly become corporatized. Our youth deserve better. We are in great need of a diversified economy and “Green Career Fairs” to reflect that. The entire provincial middle years and high school science and math curriculums have been revised to take on an industry focus. Culturally-valued education would consistently foster critical thinking, instead of applying tunnel vision.

The current provincial government has drastically cut school budgets, resulting in a loss of staff and support services for the most vulnerable. Policy must be immediately revised to not only restore but monumentally increase the ability of our schools to operate independently from industry, and serve the needs of our youth to first heal.

Local Food Sovereignty

One of the most serious barriers to health, wellbeing and learning in a region that has been long recognized as having high poverty rates, is the cost of food due to the high cost of transportation. People of the region have always been dependent on the availability of local wild foods from the land, lakes and rivers. The advent of more roads and development, and the effects of climate disasters, has hurt the health and numbers of fish and game. More and more people have had to depend on stores. It is ludicrous that we are burning fossil fuels to transport imported food when we could be developing local food sovereignty. More training in growing food and maintaining greenhouses would go a long way to eliminating both carbon emissions and would benefit the entire population. It could also provide a source of healthy, local and sustainable employment that people could take pride in.

Climate instability is going to wreak havoc on imported and domestic food crops. It is time to be realistic about creating food sovereignty in every community. It is a sad truth that people are literally only weeks away from starvation when food security is achievable.

Economic Diversity

Northern Saskatchewan has been promised “economic prosperity” for decades. It has been the key phrase used by every government wanting access to resources on and under our lands. The problem is that commodification of resources has led to over-dependence on one type of employment in resource-based, market – in other words, a boom-and-bust economy. Boom and bust is neither a reliable, nor healthy, economy. Northerners have expressed discontent to no avail. Career fairs at schools across the north continue to be funded and almost entirely represented by uranium corporations. There has been openly blatant support of the single-resource uranium economy by the Saskatchewan government. To quote Brad Wall, “The best program for First Nations and Metis in Saskatchewan is not a program at all – it’s 11 Cameco!”, and, “Cameco is Saskatchewan’s number one corporate citizen.”

Despite huge tax breaks for corporations and pitifully low royalties, government policy continues to hold us hostage to putting all our eggs in one basket, instead of promoting true prosperity within northern communities. Most people must travel hundreds of kilometers to shop for essentials or access health services that are taken for granted in the south.

A community needs and resource assessment would shed light on ways that a locally sustainable, diversified economy would better offer employment in a wider range of fields and careers, and make better use of resources. Families would not be subjected to absentee parents who are required to be away from home, and would be less stressed. Money would circulate within the local area, rather than always leaving the community.

Restore Environment to Uncontaminated State

Northern Saskatchewan was once a beautiful, pristine, green forest, with clear lakes, rivers and streams so fresh we never had any concern about taking a drink of the life-giving water. Wildlife was abundant; fish, moose, caribou, ducks and berries provided healthy sustenance. Medicines from the plants prevented and cured illness and injuries.

Over the last 60 years, uranium mining in the Athabasca Basin and nickel mining in the northeast have left permanent scars and serious chemical, heavy metal and radioactive contamination impacting the land, air, water, plants, animals and people. Even with today’s so-called “best practices” and “technological advances”, industries have to admit they fall short in ensuring that mine sites, watersheds and surrounding land will be left clear of contamination. In the case of uranium mines, there are already several permanent sacrifice zones that have been harming the health of animals, plants and people. It is also known to have intergenerational effects, reducing the ability to thrive.

It is imperative that the Saskatchewan government and its industry partners take on the responsibility for restoring all impacted areas to an un-contaminated state that will continue to be safe for all generations to come. It is their responsibility, since they did not heed the warnings given by the Dene Elders to “leave the black rock alone”. If this cannot be accomplished, then no further uranium mines and other mineral and gas development should be permitted.

Austerity and Health:Some Lessons from Around the World; Some Cautions for Saskatchewan

The People’s Health Movement – Canada (PHM‐C) agrees with the assessment of austerity’s failure as summarized by the Canadian Centre for Policy Alternatives (CCPA) in their December 2016 report The Futility of Austerity: Lessons for Saskatchewan. We would add that, even before the disastrous decade of austerity implementation proved to international financial institutions that austerity policies did not promote economic growth, overwhelming global evidence had illustrated that investments in health and education are inextricably linked to economic development (and growth). The evidence is clear: making such investments is sound economic policy.

Our submission to SaskForward is based on the work of the People’s Health Movement, a global network of grassroots health activists, civil society organizations and academic institutions guided by the goals and framework presented in The People’s Charter for Health (PHM 2000). The PHM’s Global Health Watch reports locate decisions and choices that impact health in the structure of global power relations and economic governance, and are widely perceived as the definitive voice for an alternative discourse on health. The most recent report in the series, Global Health Watch 4, was released in 2014. Our submission is also based on the thinking of several other major authors in the field, journal articles, reports, articles in the media, etc.

Public finance is a public health issue. Understanding how and why choices about the level and incidence of taxation and public expenditure affect health outcomes and health inequalities should be regarded as a core public health competence. Everywhere we observe it, austerity is selective – with resources continuing to be available for elite projects and agendas of questionable benefit, in equity terms in particular. As public health researchers, educators and practitioners we must therefore challenge the rhetoric of austerity and insist on health equity as a priority in public finance. (Schrecker 2017)

PHM‐C’s primary recommendation to SaskForward is that sustained or increased investments in publicly funded, equity‐based health programs and services are necessary to alleviate the undue suffering that Saskatchewan’s current economic crisis will continue to provoke, particularly among marginalized populations. Oppressed groups often suffer even more under austerity conditions as a results of budget cuts to particular programs, and for this reason we need to pay particular attention to the social determination of health (and ill‐health) among the Indigenous peoples of the province.

In this submission we make several observations of the observed effects of austerity on health outcomes, drawing from the experiences of countries in the European Union (EU) where austerity has been more extensively studied. We examine those effects more closely though an extreme case study of austerity (Greece). We then explore several current Canadian issues related to health care cuts, and end with considerations of the longer‐term impacts of austerity policies through the three policy interrogatives.

1. Who Are We?

Globally the People’s Health Movement operates in more than 70 countries. Within countries and regions, it operates to mobilize support for addressing global health crises caused by growing inequities within and among nations. This is accomplished through local and regional mobilizations, campaigns and awareness‐raising. At the global level the PHM’s major activities centre on watching, documenting and educating activists’ struggles for health; these include the WHO Watch, Global Health Watch publications and International People’s Health University (IPHU) teach‐ins. At the regional level issues and struggles vary and so do mobilizing strategies.

Within Canada we are a small network of concerned individuals and organizations linked primarily through a list‐serve and regular communications. While most of our activist work is undertaken through local initiatives – not necessarily identified as ‘PHM activities’ – we share the PHM’s global commitment to comprehensive primary health care and addressing the social, environmental and economic determinants of health. We also coordinate with and cooperate on issues and campaigns as part of the regional North America chapter. Our most recent regional event was a one‐day North America Regional People’s Health Assembly, held in August, in conjunction with the World Social Forum. More recently, PHM‐ Canada made a submission to the Expert Panel Review of Environmental Assessment Processes entitled Why We Need to Remember Health in This Conversation (PHM‐C 2016).

2. Overview: Causes of the Causes

In health terms, economic policies are often considered “the causes of the causes.” While they do not produce disease pathogens directly, they affect health by exposing particular groups of people to more or less risk, particularly but not solely, by their effects on social health determinants and health‐determining processes. Economic policies and trends can determine who gets or doesn’t get income supports and educational opportunities; they can also can determine who is “more likely to binge on alcohol, catch tuberculosis in a homeless shelter, or spiral into depression” (Stuckler and Basu 2013: 139).

Research linking economic policies and trends to health outcomes has suggested cumulative, unequal, and intergenerational effects. In an extensively cited research briefing by the UK organization Psychologists Against Austerity, for example, evidence shows that austerity policies can have damaging health effects intergenerationally with ”further problems … being stored for the future” (Psychologists against Austerity 2015). The latest research has begun to demonstrate plausible models for the epigenetic transmission of health responses to stress across generations, meaning our choices now that undermine the resilience of already vulnerable communities will have a social cost many decades into the future (Franklin et al 2010, Bowers and Yehuda 2016). We will discuss the health impacts of adverse childhood events in more detail later.

Numerous articles in reputable health journals document how the Great Financial Crisis which began in 2008 and the ill‐conceived austerity policies implemented in its wake have affected health both directly and indirectly. Directly, both health system and population health outcomes are affected and recorded in terms such as health system coverage, unmet health needs, health worker to population density, and morbidity, mortality and self‐ reported health status statistics and reports. Less direct effects are the effects of austerity policies on social determinants of health such as housing, income, food security and employment. While both direct and indirect effects can be studied, the PHM‐C suggests that assembling the case of ‘austerity and health’ requires both an understanding of the political economy of health and the kind of data that can provide for a robust analysis of trends.

To that end, the PHM‐C suggests that the more health and socio‐demographic data that is available, and the more detailed those data are (sufficient to allow disaggregation by gender, ethnicity, geographic location, etc.), the better able critical researchers and health activists will be able to track these trends. Accurate and detailed data allows for the production of solid evidence that can challenge the ideological positions often used to justify cuts to wages, programs and services.

3. Neoliberalism, Austerity and Health

According to analyst Richard Seymour, the popular representation of austerity as ‘short term spending cuts’ disguises its connection to the pernicious doctrine of neoliberalism, of which it is part and parcel. He suggests that rather than a simple set of policies to erase short‐term deficits under the auspices of austerity, we are seeing a fundamental neoliberal shift that includes: 1) a drastic long‐term ‘rebalancing’ of economies from consumption toward investment – or “away from wages and towards profits”; 2) growing strength of financial capital, and the corresponding spread of precariousness in all areas of life, most notably precarious work; 3) increased social inequality and stratification within classes; 4) growing fusion of the interests of states with that of corporations; 5) reorganization of the state from welfarist toward penal and coercive orientations; and, 6) dissemination of cultures which value hierarchy, competitiveness and “casual sadism toward the weak” (Seymour 2014, p. 3). Not all of these aspects of the shift are considered here, but are all inextricably linked to societal well‐being and would be useful to keep in mind in our collective analysis.

The PHM’s perspectives on the health crises of neoliberal globalization are set out in Chapter A1 of Global Health Watch 4. The chapter sets out a periodization and typology of three forms of neoliberalism:

 Neoliberalism 1.0: Structural adjustment

 Neoliberalism 2.0: Financialization

 Neoliberalism 3.0: AusterityWith regard to the third phase, austerity, the report notes that:The stunning failure of the 2008 crisis to delegitimize neoliberalism reveals the extent to which public policy had been influenced by the private sector (and primarily financial institutions). Neoliberalism was never about eliminating the state; instead, it was about occupying it, ‘a reconfiguring of both (state and market) so that they become thoroughly enmeshed.’ The ‘austerity agenda’ is merely one of the means of completing this phase of neoliberalism. Its key tenets differ little from those of Neoliberalism 1.0 … One key difference is that these policies are now a global phenomenon affecting high‐income countries as well. Contrary to widely held assumptions, however, this fiscal contraction is still most severe in the developing world.

and concludes that:

There is, in fact, robust evidence that every dollar in public spending can generate more than a dollar in economic growth in the ‘real economy’ of production and consumption, by purchasing goods and services that employ people, by employing people who purchase other goods and services, and by signalling stability to the private sector, which is then motivated to undertake its own increased activity. In the post‐[Global Financial Crises] environment, government spending is thought to have an average fiscal multiplier effect of 1.6. Recent estimates of European public spending by sector show much greater multiplier impacts for investments in health, education and environmental protection than, for example, in defence. Other data from Eurozone countries show that governments with higher rates of spending are recovering faster from the 2008 GFC. There is similar evidence available from the United States as well. Emergency unemployment benefits, extended by the US government in the wake of the GFC, are credited with reducing the economic impacts of the recession. These emergency benefits ended in December 2013 for 1.3 million Americans, which one economist estimated is costing the US economy US$1 billion a week, owing to decreased spending by the jobless.

Simply put, government spending in the health and social protection sectors is not only good for health equity and social stability, it is also good for the economy. Even the World Bank and the International Monetary Fund (IMF) have begun to accept the empirical evidence of the shortcomings of austerity, calling for government caution in implementing public sector cutbacks in recognition of the ‘fiscal multiplier’ effect of government spending.

The health‐harmful effects of austerity are being better documented and becoming more widely known. This evidence in itself provides health activists with strong arguments to reject austerity. Even by the standards of very mainstream economics, austerity simply does not make any sense. Say it loudly. Say it often.

4. Austerity and Health in the European Union (EU)

Perhaps more rigorously studied than other regions of the world, studies of the health effects of austerity regimes in the European Union (EU) have suggested that both national austerity policies specifically, and the legal obligation to adopt very low deficits that EU member states face have led to legal requirements for cuts to social spending. When imposed on health systems, these have translated as legal limits on health spending, with consequences for quality and access (Legido‐Quigley and Greer 2016).

As Schrecker and Bambra explained in their 2015 book How Politics Makes Us Sick: Neoliberal Epidemics, cuts to social spending and their effects have been not distributed evenly across societies. In describing the consequences of recent economic and social policies as ‘neoliberal epidemics’ they combined or conflated three categories: a health outcome of rising concern (obesity, one of many outcomes they could have chosen); key social determinants of health outcomes (economic inequality and insecurity); and a policy driver of those social determinants (austerity). Schrecker and Bambra felt that this conflation was justified because (a) an abundant evidence base connects inequality, insecurity and austerity with adverse health outcomes, of which obesity is only one; (b) the phenomena in question exist on such a scale and have spread so quickly across time and space that if they involved pathogens they would be seen as of epidemic proportions; and, (c) the epidemics in question are direct consequences of neoliberal economic and social policies.

Within vulnerable populations of European societies, increased stress due to economic hardship has resulted in marked increases in mental stress and depression (Psychologists Against Austerity 2015) and increased risk of initiating substance (alcohol, smoking, illicit drug) use (Dom et al 2016). Specific attention must be paid to the impact of austerity measures on rates of mental distress and suicide behavior over the life course. Recent research from Scotland has demonstrated that “The risk of suicide increased … for those born between 1960 and 1980, especially for men living in the most deprived areas, which resulted in a rise in age‐standardised rates for suicide among young adults during the 1990s. This is consistent with the hypothesis that exposure to neoliberal politics created a delayed negative health impact.” It is profoundly important to note that the impact of austerity policies were greatest on “men living in the most deprived areas” of Scotland. These path‐breaking findings follow on research which outlined the broader impacts of the neoliberal “political attack” on health in Scotland (Collins and McCartney 2011).

5. Greece: An Extreme Case Study

The effects of austerity on health in Greece have been studied intensely. Although Greece as a country has a socio‐economic context and health system that is distinct from Canada and Saskatchewan, the intensity of both the measures of austerity imposed after 2010, and the clear health effects experienced provide a cautionary tale.

In Greece, the financial crisis of 2008 led to successive rounds of austerity imposed by the Troika (the European Commission, the European Central Bank and the International Monetary Fund) as conditions for loans from the IMF. These conditions included drastic cuts to health care coverage, prevention and treatment for Greek citizens such as: the requirement of a cap of 6% GDP for expenditure on healthcare; reduction by 10% of public health expenditure on pharmaceuticals; cuts to hospital budgets and to harm reduction programs (1/3 of street health programs cut; syringe and condom distribution cuts of 10% and 24% respectively) and cuts to municipal budgets for public health activities (e.g. mosquito spraying programs). Cuts to mental health programs and coverage were also reduced 20% from 2010‐2011 and a further 55% from 2011‐2012 (Kentikelenis et al 2014).

Unsurprisingly, according to the Bank of Greece’s own admission, “the large cuts in public expenditure have not been accompanied by changes and improvements of the health system in order to limit the consequences for the weakest citizens and vulnerable groups of the society” (Bank of Greece 2016). Below is a short compendium of published health effects, trends and outcomes since the establishment of these policies:

35,000 clinician jobs slashed (Stuckler and Basu, 2013); 15% cuts in health worker salaries, 10% cuts in pensions; retirement age has increased from 65 to 67; about 1/3 of graduate nurses will remain unemployed for up to four years upon graduation; high levels of job dissatisfaction and burnout for nursing staff (Simou and Koutsogeorgou 2015). Between 2009‐2014, 120,000 mostly post‐graduate level university‐trained professionals had left Greece, among which were more than 3000 newly graduated doctors (Rodgers and Stylianou 2015).

 Increased health inequalities: the proportion of individuals on low incomes reporting unmet need due to cost doubled from 7% in 2008 to 13.9% in 2013, while the unmet need among the richest population quintiles decreased, leading to a ten‐ fold increase in the health gap between the rich and poor (Bank of Greece 2016; Karanikolos and Kentikelenis 2016).

The prevalence of major depression increased from 3.3% in 2008 to 6.8% in 2009, to 12.3% in 2013 (Bank of Greece 2016; Economou et al 2016).

These appalling changes in health outcomes have occurred in a country that is part of the European Union. While we in Saskatchewan will likely never experience the severity of these cuts and the magnitude of these changes in health outcomes, the Greek example clearly suggests the direction of direct health effects due to changes to health care systems, worker, coverage and programs in an austerity regime.

6. Canada

In Canada a steady slow erosion of public services spending starting with Paul Martin’s austerity budgets. In the Harper years, a slowing down of public share of total health spending was accomplished by not increasing the percentage of health spending to GDP ratio, which resulted in health transfers stagnating.

Fast forward: throughout December and January of 2016, after a failed attempt at a federal‐ provincial agreement regarding health transfers, provinces representing smaller populations – including Saskatchewan – began making bilateral agreements on transfers. This form of backroom bilateralism is flawed for several reasons:

According to NDP health critic Don Davies, the side deals are divisive and break the spirit of ‘collaborative federalism’ and “end up posing a threat to the uniformity enshrined in the Canada Health Act.” For the Canadian Medical Association, “A national and strategic approach to improving our health care system remains essential” (Kirkup 2017).

The federal government’s insistence on funding of mental health and home care, rather than allowing provinces to tailor a robust transfer to their own needs, is known globally as the vertical program approach to health funding. Authoritative sources have documented multiple countries where the approach has had a devastating effect on health systems worldwide, contributing to fragmentation of health systems (Kentikelenis et al 2014).

Within Canada, perhaps more fundamentally, the formula for health transfers is questionable. The Canadian Health Coalition suggests have that“negotiations regarding the health transfer have missed the mark when it comes to addressing the needs of Canadians,” “While the negotiations have been centred on 3% or 6%, no one has been talking about how to ensure the funding can continue to deliver the services Canadians need. Tying the health transfer to GDP means that when the economy tanks and health care needs increase, there will be fewer dollars available.People without jobs and health benefits rely more heavily on the public system to meet their medical needs. We need funding that reflects the needs of Canadians, not the fluctuations of markets” (Canadian Health Coalition 2016).

Ottawa’s share of public health‐care spending, currently about 22 per cent, is set to fall to about 18 per cent within a decade (Yakabuski 2016).

We suggest that these current moves reflect the competitive, divide and conquer doctrine of neoliberalism, and set the stage for provincial governments to roll out and excuse their own policies under the blanket of austerity. As noted above, we in PHM Canada do not believe that clear trends in wealth concentration amongst the richest in the country that have emerged since the last round of austerity twenty years ago in Canada are unrelated to the dampened economic growth rates that we have experienced over the last decade. The most dynamic economies are those that support the spending of the poor and middle classes, who push supplemental income into the marketplace, rather than hoarding it as has been the tendency of the wealthy. These vibrant economies are more likely to support steady employment to a wide swathe of the population, with security and social conditions that support the well‐being and health of the whole community.

7. Policy Interrogative 1: What will be the direct and indirect health consequences if the current downturn in Saskatchewan’s economic situation is of a longer duration than the provincial government believes likely?

Austerity policies are often sold to the public as short‐term measures required to allow governments to manage fiscal pressures during a period of economic downturn, the assumption being that cuts can be reversed once robust economic growth resumes. Whether or not one agrees with this ‘belt‐tightening’ logic, there is another question that must be asked: what if global economic growth rates remain low, commodity prices remain low, and the pressure on the provincial government budget remains elevated?

In its latest economic outlook, released on January 16, the IMF estimates that Canada’s economy grew by just 1.3% in 2016, and is forecast to grow by 1.9% in 2017 and by 2.0 in 2018 – the same rates as for the ‘advanced economies’ as a whole. The IMF estimates just 1.6% annual real GDP growth for the ‘advanced economies’ in 2016, down from 2.1% in 2015 and down from its July 2016 forecast of 1.8%. (IMF 2017) This is primarily the result of the US having experienced the weakest economic recovery after a slump since the 1930s. Maurice Obstfeld, the IMF’s chief economist, has noted that “The crisis has left a cocktail of interacting legacies – high debt overhangs, nonperforming loans on banks’ books, deflationary pressures, low investment, and eroded human capital – that continue to depress potential investment levels” (Coy 2016).

Economic growth in the US is not forecast to rise beyond 2.5% in 2017 or 2018, and the IMF update notes that “there is a wide dispersion of possible outcomes around the projections, given uncertainty surrounding the policy stance of the incoming U.S. administration and its global ramifications.” That is far below the rate of 4% that US President Donald Trump has claimed that his proposed policies would achieve. ‘Trumponomics’ – tax cuts for corporations and the rich, private spending on infrastructure, and quantitative easing – may prove to be no more successful at generating economic growth than Japan’s ‘Abenomics’… although it may boost financial markets and launch a speculative boom. This is the reality of the world economy today.

If global – including Canada’s and Saskatchewan’s – economic growth rates stagnate, and if the province’s corporate taxes and royalty regimes are not increased, will Saskatchewan’s public health care system be slashed in the same way that Trump is planning to slash public health care in the US? What would be the direct and indirect health consequences to the people of the province, especially the least well‐off?

8. Policy Interrogative 2: Might the greatest impact of the provincial government’s austerity agenda be felt in decades to come, as a result of elevated rates of adverse childhood experiences?

There is an enormous body of evidence showing the negative health impacts of adverse childhood experiences (ACEs) over the life course. Two key studies in this regard are the Adverse Childhood Experiences study in the US [1] and the Christchurch Human Development Study (CHDS) in New Zealand. [2]

The US ACE’s overall findings were that there is “a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.” (Felitti 1998)

Of specific relevance to economic policy is the ACE study’s publication which examined “the relation between eight types of adverse childhood experiences (ACEs) and three indicators of worker performance (serious job problems, financial problems, and absenteeism)” later in life: “Strong graded relations were found between the ACE Score (total number of ACE categories experienced) and each measure of impaired worker performance. We found strong evidence that the relation between ACE Score and worker performance was mediated by interpersonal relationship problems, emotional distress, somatic symptoms, and substance abuse” (Anda et al 2004). The authors concluded that: “The long‐term effects of adverse childhood experiences on the workforce impose major human and economic costs that are preventable. These costs merit attention from the business community in conjunction with specialists in occupational medicine and public health.”

The implications of the US ACE study and the CHDS are clear: spending cuts which put additional stress on families can result in children experiencing higher rates of ACEs. Higher rates of ACEs mean not only greater human suffering, but also higher demands on the health care system over the long term.

The alternative is to maintain – or increase – what American researcher Stephanie Seguino has termed social infrastructure investment, which “can in fact be self‐financing. This is because such expenditures, by promoting human well‐being, also raise economy‐ wide productivity, and stimulate development and growth. As a result, this type of spending stimulates an increase in taxable income in the future with which to finance the original costs of the expenditures. Thus, human development expenditures can create fiscal space, an effect that is more easily understood once we adopt a longer time horizon than is typically done” (Seguino 2016).

Seguino notes that research on ACEs “is an instructive example of the type of research that can help economists estimate the costs of “doing nothing” versus investing in ameliorating the lives of children through public spending on mental and physical health care, training for parents, as well as policies that improve the economic well‐ being of families.” She concludes: “These studies demonstrate that there are positive externalities to be had from publicly funding investments in what we might call the social infrastructure – the bedrock on which the entire economy is built. This is not to suggest that the purpose of social spending should be purely instrumental. Rather, it demonstrates that such spending is in fact mischaracterized as merely a cost. Research has demonstrated that social spending is affordable because of its effects on well‐being that have economy‐wide effects.”

Does the provincial government understand the life‐course impacts that austerity policies may have on the most marginalized members of our society? If so, how does it plan to protect the well‐being of vulnerable children as its cuts take effect?

9. Policy Interrogative 3: Will data of sufficient richness to allow detailed monitoring of the impact of austerity on health over time, disaggregated by geography and population cohorts, be made available to the public and to analysts?

Citizens are entitled to accurate and accessible data on the state of their society. Given the scale of the austerity measures which the provincial government may be about to implement, it is imperative that data systems of sufficient richness to allow detailed monitoring of the impact of austerity on health over time.

Recent research in the US has shown how changes in mortality and morbidity patterns have been structured by ethnicity, sex and age with “a marked increase in the all‐cause mortality of middle‐aged white non‐Hispanic men and women in the United States between 1999 and 2013” (Case and Deaton 2015). Data from the Centers for Disease Control and Prevention are available at the county level, which allows for nuanced understanding of epidemiological transition. For example:

Will data of sufficient richness to allow detailed monitoring of the impact of austerity on health over time, disaggregated by ethnicity, sex, age and geography, be made available to the public and to analysts? It will be especially important to be able to measure the impact of government austerity measures on indigenous peoples and other vulnerable sections of the population.

10. Conclusion

Austerity involves the redistribution of costs in society onto communities that already bear considerable burdens. With the rollback of the formal care sector, caregiving work – whether it be acute medical care or long‐term disability care – falls to individuals and families, where it is overwhelmingly women who do the work. As the demands of this increased caregiving load often falls onto women, their own health falls under strain. Often the last to seek care for themselves, many may find themselves in emergency situations. Migrant workers who may already feeling pressure from precarity may find their working conditions further eroded, thereby exacerbating chronic conditions, their health further compromised by racist violence whipped up by mythologies of scarcity. Indigenous peoples may find the obligations of health services to them under treaty law compromised by rhetoric about limited resources, when in reality, the long goal of neoliberalism under the guide of austerity is to distribute resources away from the vulnerable towards those with power.

Case, Anne, and Angus Deaton. (2015) “Rising morbidity and mortality in midlife among white non‐Hispanic Americans in the 21st century.” Proceedings of the National Academy of Sciences 112:49. http://www.pnas.org/content/112/49/15078.full.pdf

Coy, Peter. (2016 October 19) “Global markets stumble into a high‐debt, low‐investment 2017: Next year will be mediocre at best.” BloombergBusinessWeek. https://www.bloomberg.com/news/features/2016‐10‐20/global‐markets‐stumble‐ into‐a‐high‐debt‐low‐investment‐2017

Dom, Geert, et al. (2016) “The impact of the 2008 economic crisis on substance use patterns in the countries of the European Union.” International Journal of Environmental Research and Public Health 13:1. http://www.mdpi.com/1660‐4601/13/1/122/htm

Seguino, Stephanie. (2016) “The costs of inequality and the affordability of solutions.” Journal of Human Development and Capabilities 17:3. http://www.tandfonline.com/doi/full/10.1080/19452829.2016.1203029

Seymour, Richard. (2014) Against Austerity: How We Can Fix the Crisis They Made. Pluto Press.

Yakabuski, Konrad. (2016 March 28) “Provinces will feel the bite when it comes to health care transfers.” The Globe and Mail. http://www.theglobeandmail.com/opinion/provinces‐will‐feel‐the‐bite‐in‐health‐ transfers/article29388708/

NOTES

https://www.cdc.gov/violenceprevention/acestudy/. The full range of publications from the ACE study are available at http://www.cdc.gov/violenceprevention/acestudy/outcomes.html, helpfully organized by the health outcomes studied.

http://www.otago.ac.nz/christchurch/research/healthdevelopment/index.html. The articles, reports, books and book chapters describing what has been learned from study of the CHDS cohort are listed at http://www.otago.ac.nz/christchurch/research/healthdevelopment/publications/

The Government of Saskatchewan’s announcement following the budget of 2016 to launch a “transformational” agenda in response to a massive deficit was a puzzling and confusing political move. What exactly did Premier Wall have in mind? What magnitude of change was the government considering? Transform has two different meanings, “to change the outward form or appearance” or “to change in character or condition/potential”. (Webster’s) Within a few months and after several government announcements it has become clear that the government is intent on changing the character of governance in the province.

Poverty Free Saskatchewan (PFS) has been advocating for a systematic approach to poverty elimination since 2009, identifying six pillars for addressing poverty: housing access and affordability; income security for vulnerable groups; education, training and early childhood learning and development; enabling and rewarding work and participation in our communities; improving access to and quality of services for low income people; and, promoting health and preventing illness. PFS has also been advocating for a provincial legislative Act on poverty elimination.

Aboriginal children experience poverty at much high rates than others in the province. Of the 55,000 children living in poverty in 2010 31,000 were First Nations and Métis. How will the province ever transform their lives unless Indigenous people are fully included in anti-poverty planning and response?

PFS proposes that the government missed a huge opportunity to undertake positive transformational change when it failed to move forward on the anti-poverty file. The government ignored some important recommendations of the Advisory Group on Poverty Reduction and has not come forward with a real poverty reduction plan, instead implementing cutbacks contrary to poverty reduction. Yet the provincial government says it is committed to implementing the Truth and Reconciliation Commission Calls to Action. PFS is calling on government to transform its approach to poverty and include more initiatives that address Indigenous child poverty. If the government were to construct a well thought out anti-poverty plan and included the TRC Calls to Action then it would be finally on its way to reaching its poverty reduction target. If it just gives lip service to TRC, anti- poverty gains will not be made.

Saskatchewan Government Poverty Reduction Strategy
In December 2014, the government of Saskatchewan initiated the development of a Poverty Reduction Strategy and appointed an Advisory Group on Poverty Reduction (AGPR) to guide the process. The AGPR was mandated “to review past and ongoing initiatives that address poverty, identify key gaps and opportunities to reduce the incidence of poverty in Saskatchewan, and make recommendations to government to inform the future development of a Poverty Reduction Strategy.” (1) From the outset, it was clear that the AGPR was not empowered to produce a poverty reduction plan, instead it was to merely inform the government about identifying ways forward. Most importantly though, the AGPR report did recommend that the government utilize a comprehensive, integrated approach, and create an implementation plan with targets, timelines and a budget aimed at reducing poverty. This is an important and necessary structural approach to attacking poverty; moreover, this template has been put forward many times in the past by various community groups and academics, including Poverty Free Saskatchewan.

The AGPR report also acknowledged the recommendations of the federal Truth and Reconciliation Commission (TRC). The AGPR report stated, “Respecting the dignity of First Nations and Métis people includes addressing the consequences of colonialism, residential schools and ongoing racism.” Recognition of the TRC’s Final Report was an important step forward by AGPR and identifies ways in which the provincial government could support the TRC report’s recommendations.

The government reviewed the recommendations of the AGPR report and in February 2016 released the Saskatchewan Poverty Reduction Strategy (SPRS).

The Minister of Social Services at that time, Donna Harpauer, in the introduction to the SPRS report, set forth the long-term poverty outcome of the government. She stated, “We have set an ambitious goal to reduce the number of people who experience poverty for two years or more by 50 per cent by the end of 2025.” (2) The report, however, failed to provide a working definition of “people who experience poverty for two years or more”; nor did it identify any methodology for establishing this metric and calculating it on an ongoing basis. Thus, one of the key measurements of progress toward poverty reduction is just a vague political promise.

Under housing and homelessness, the SPRS recommends no specific targets for the increase of social housing that would be needed by 2020.

The early childhood development and childcare section does not provide any actual numbers of child care spaces required or how to develop a high quality affordable child care system.

The education section puts much emphasis on increasing the number of students attaining a grade 12. This has been a government target for many years. Increasing investment in public, Catholic and band schools to help attain this target is long overdue. Also, there is little emphasis on a job creation strategy, or how education and employment targets for First Nations could be improved.

The health and food security recommendations lack targets and justification for the limited measures identified.
Although the SPRS report identifies six key components of a poverty plan, it does not identify any changes to government structures to carry out the policy and program changes necessary to affect the lives of those most affected by poverty. The report suggests an independent review body but does not indicate whether this work could be accomplished by a task force, a special poverty office or a new government department. Without a pathway to move the recommendations forward they can easily by lost in the complex relations among ministries.

Unfortunately to date an actual plan, which is needed to implement this Strategy, has yet to see the light of day. Instead of an expansion of social and economic benefits and protections we are seeing announcements of broad-based funding cuts to social, health and education programs that support our most vulnerable citizens.

Addressing the Truth and Reconciliation Commission Calls to Action
In December 2015 after six years of study and deliberation of the history and legacy of Canada’s residential school system the Truth and Reconciliation Commission tabled its report along with 94 Calls to Action. The report estimated that 3200 (5%-7%) of enrolled students enrolled in the residential school system died from tuberculosis, malnutrition and other diseases resulting from poor conditions. Separation of Indigenous children from their parents resulted in lifelong negative impacts on both children and parents and destabilized indigenous culture for generations. While its recommendations are comprehensive, the Commission was set up to address the damages related to residential schools. First Nations people were provided some compensation for those harms. The TRC could not recommend any damages for other impacts of colonialism such as loss of land, loss of control over resources or any other losses at odds with Canadian sovereignty. (3)

The TRC urges all levels of government, federal, provincial, territorial, and Aboriginal to work together to change policies and programs in a concerted effort to repair the harm caused by residential schools. Call to Action 53 recommended establishment of an independent national oversight body to monitor, evaluate and report to Parliament on implementation progress to ensure government accountability. To date no such body has been created thus it is difficult to ascertain what implementation progress is being made by the federal or provincial governments, despite all the verbal commitments. The Assembly of First Nations promised to develop an action toolkit and a progress report to present at the 2016 annual general gathering. Prime Minister Trudeau announced a five-point plan in response to the TRC including: setting up a public inquiry into missing and murdered indigenous women and girls, lifting of the two per cent cap on funding First Nations programs, making significant investments in education, implementing all 94 recommendations including the United Nations Declaration on Rights of Indigenous Peoples and finally, agreeing to meet with the four First Nations leaders after the final report was tabled. The public inquiry into missing and murdered indigenous women is underway but progress on other Calls to Action is unclear.

The TRC Calls to Action related to the justice system require wide ranging responses from the provincial government that are closely correlated with poverty elimination. These include “eliminating the overrepresentation of Aboriginal people in custody, provide sufficient and stable funding to implement and evaluate community sanctions that will provide realistic alternatives to imprisonment”, address and prevent Fetal Alcohol Spectrum Disorder, “ work with Aboriginal communities to provide culturally relevant services to inmates on issues such as substance abuse, family and domestic violence, overcome the experience of having been sexually abused” and finally, commit to eliminate the over-representation of Aboriginal youth in custody over the next decade. (4)

Call to Action 55 requests all levels of government to provide annual reports on such indicators as number of Aboriginal children in care, compared with non-Aboriginal, reasons for apprehension and total spending on preventative and child care services, comparative funding for education of First Nations children on and off reserves, educational income and outcome attainments of Aboriginal people, and progress on closing the gaps between Aboriginal and non-Aboriginal communities with respect to a number of health indicators such as: infant mortality, maternal health, suicide, mental health, addictions, life expectancy, birth rates, infant and child health issues, chronic diseases, illness and injury incidence and the availability of appropriate health services. (5)

There is much overlap between the TRC funding, monitoring and reporting demands and what would be automatically evaluated and rolled up into a high quality, well integrated anti-poverty plan.

Canadian Premiers voiced their support for the Call to Action, including Premier Wall. The Government of Saskatchewan’s media release and web page stated “the government committed to meeting this task (TRC Calls to Action) through the adoption of practical solutions. We will create a multi-ministry team to carefully examine this report and the full report once released. We will look to build on successes, such as teaching Treaty and First Nations and Métis histories in the classroom and the Joint Task Force on improving education and employment outcomes for First Nations and Métis people. The recommendations and the stories conveyed throughout the Commission’s work will be critical to informing Saskatchewan’s future efforts toward reconciliation.” (6)
The Saskatchewan government’s web page sets out the inter-ministry strategies to implement the TRC and highlights the following achievements:

Joint Task Force (JTF) on Improving Education and Employment Outcomes for First Nations and Métis People

The government has made good progress in addressing the JTF’s recommendations; many of those recommendations are echoed in the work of the TRC.

What does good progress mean? To what extent has the gap closed between Aboriginal education an employment outcomes and non-Aboriginal employment and education outcomes?
How has the Saskatchewan Poverty Reduction Strategy addressed the poverty of Indigenous people?

The Advisory Group on Poverty Reduction heard from a wide range of community stakeholders, including persons from First Nations and Métis organizations.

The advisory group’s recommendations include the principle of respecting the dignity of First Nations and Métis people, which also includes addressing the consequences of colonialism, residential schools and ongoing racism.

The recommendations also include enhancing early childhood services and educational and employment outcomes for First Nations and Métis people.

Although, the government has produced the Saskatchewan Poverty Reduction Strategy, but a real implementation plan has not been released.

Unfortunately, the recommendations of the AGPR have not been fully recognized. The government’s Poverty Reduction Strategy did not accept AGPR’s more stringent poverty reduction target; it has not established a basic income pilot project; it has not supported living wage initiatives, nor has it advanced new policies and programs to overcome structural causes of poverty such as assessing health outcomes in all new anti-poverty policy development.

Saskatchewan Disability Strategy

A key recommendation in the Disability Strategy is to ensure that First Nations, Métis and Inuit people experiencing disability are well-supported regardless of their home communities.

Responding to this recommendation will require discussion with the federal government and First Nations.

In 2016, unfortunately we have seen funding cutbacks to benefits programs. While some people who previously received benefits will continue on, others who are new to programs, or change housing locations, will not receive the same level of benefits. These include cuts to: the Saskatchewan Assistance Plan, Saskatchewan Assured Income for Disability, the Seniors Income Plan, and the Saskatchewan Employment Supplement. In addition, the Saskatchewan government is now counting the federal Guaranteed Income Supplement as income after the age of 65

Mental Health and Addictions Action Plan

The Ministry of Health is leading the development of cross-ministry implementation of the 10-year Mental Health and Addictions Action Plan.

One of the plan’s key recommendations is to partner with First Nations and Métis people in the planning and delivery of mental health and addictions services, to better meet community needs.

This is one of 10 recommendations that have been prioritized to take place over the next four years.

Has the government provided any monitoring, funding, reporting of mental health outcomes? Are there any government reports on TRC Calls to Action 33-38?

Child Welfare Transformation Strategy

The Child Welfare Transformation Strategy has three themes:
1) Work differently with First Nations and Métis people
2) Increase prevention and support for families; and
3) Renew the child welfare system.

The Ministry of Social Services is committed to working differently with First Nations and Métis people to provide the best possible child welfare services and outcomes for children and families.

First Nations and Métis people have been engaged in the strategy and will continue to be engaged as the child welfare system is transformed and continually improved.

The focus of Saskatchewan’s current practice is to strengthen the family home to support children to remain safely at home and/or to safely return home from being “in care” with the ministry.

A review of child welfare legislation has taken place with new legislation anticipated in 2017.

The Child Advocate and others have documented many issues related to the child care system in Saskatchewan as it relates to First Nations children.
A recent study by the University of Regina, Department of Social Work revealed for the first time the extent of child poverty among Indigenous and other Saskatchewan children. (7)

 For children in First Nations families, the poverty rate in 2010 was 59.0 per cent. Among those families indicating they were Métis, 25.9 per cent were in low-income households. In 2010, of the 55,000 poor children in Saskatchewan, 31,000 were in First Nations or Métis families.

 The child poverty rate for children in immigrant families in 2010 was 27.1 per cent and for those in non-immigrant visible minority families was 19.3 per cent.

 Depth of poverty was greater in the Prairie provinces than in other Canadian provinces. In Saskatchewan in 2014, the income for one-half of families in poverty was at least $12,000 to $13,000 below the poverty lines.

Transformational Opportunity
It is abundantly clear that if the province wishes to create a positive future for all we must greatly reduce the numbers of children in poverty and particularly indigenous children. The TRC Calls to Action demonstrate that redressing the legacy of residential schools and advancing reconciliation will only occur if the root causes of poverty are addressed. The AGPR report suggested some ways forward; however, the government continues to ignore the report’s most important recommendations.

Poverty Free Saskatchewan’s publication Budget 2016: Transformation or Austerity? documents the negative effects of the government’s diminishing social expenditures, which inevitably create increased social exclusion and inequality and higher longer term costs to government. Most recently the government has decided to centralize all the regional health authorities and has recommended amalgamation of Saskatchewan’s school boards creating confusion and disruption and an unknown number of job losses. Governance is about how power is distributed and shared at the provincial and local levels and how accountability is rendered. Therefore, a redistribution of more power to the provincial government at the expense of the regions and local communities will produce minuscule savings and merely create more disaffection toward the current provincial government system.

Since 2009 Poverty Free Saskatchewan has advocated for a poverty elimination plan and since 2014 for a Saskatchewan Anti-Poverty Act which entrenches the human rights the province is committed to in the United Nations International Covenant. Such legislation is the essential ingredient of an effective anti-poverty plan and would allow us to once again play a leadership role in pioneering progressive social legislation. Most importantly it would provide needed protections for our most vulnerable and disadvantaged citizens, especially children in poverty.
Real transformation would occur if the government would undertake the following:


Pass legislation to establish an Anti-Poverty Act.

Set up a multi-discipline anti-poverty office and develop a comprehensive and integrated anti-poverty plan that takes account of the TRC calls to action.

Implement a multi-year plan, with a dedicated budget, that is in full compliance with the Anti-Poverty Act, with a dedicated budget and reporting of annual progress to the legislature.

POVERTY FREE SASKATCHEWAN: OUR BELIEFS
PFS is a network of individuals and organizations working to eliminate poverty in the province since 2009. The province has many other individuals, businesses and community organizations working to alleviate the harmful effects of poverty and address the root causes of poverty. Working together more closely, we can eliminate poverty.
Poverty has serious consequences. The Poverty Costs campaign estimated spin off costs of poverty to be $3.8 billion, about five per cent of the province’s gross domestic product.
The guiding principles underpinning PFS’s anti-poverty strategy are:
• A focus on vulnerable groups;
• Community involvement carried out through meaningful province-wide engagement processes that hears from all vulnerable groups and includes them in planning and implementation of strategies and programs;
• Anti-poverty targets timelines for achievement and performance indicators to be met; and
• Adoption of government accountability mechanisms that are clearly set out in a Saskatchewan Anti-Poverty Act.

PFS’s strategies to eliminate poverty were developed and have been communicated to the public and government. These strategies must cut across key issue areas and be supported by investments in the following:
• Housing access and affordability;
• Income security for vulnerable groups;
• Innovation in education, training and early childhood learning programs;
• Enabling and rewarding work and participation in our communities including support for a living wage;
• Improving access to quality services for low income people; and
• Promoting health and preventing illnesses among vulnerable groups, including food security initiatives.

There is an alarming need for additional resources to be directed towards addiction treatment in Saskatchewan. While there is a cost associated with addictions treatment, the corresponding savings to the people of Saskatchewan through reduced use of social programs, reduced emergent and long term medical care and reduced need for policing far outweigh that cost. Further, there is substantial societal benefit.

The current fentanyl crisis is killing people at unheard of rates and may soon arrive in Saskatchewan. In order to get ahead of this crisis, Saskatchewan needs proactive steps to help addicts obtain treatment when they ask for the help.

I am writing as a mother of an adult son who has fought with addiction for years. My son has participated in counseling through the health region’s Addictions Services, has been though the Wakamow Detox Centre and has attended Calder Treatment facility on three occasions. Unfortunately, each time he has relapsed, and with each relapse the drug use has increased.

Despite the dedication and hard work of staff at these facilities, the evidence is clear: 28 to 35 day programs are not sufficient. In addition, the existing programs do not contain sufficient life skill training or personal counseling; they also do not have any type of transition back into the regular day to day stress of work and life that often trigger the addict to relapse.

Lastly the fact that Calder and Pine Lodge are the only two Sask Health funded programs in Saskatchewan means that the vast majority of addicts lose the community support they have established when they return home after treatment. When an individual completes treatment he/she is discharged with little support beyond the limited appointment time available through addiction services.

I am happy to say that my son is participating in a treatment program in New Westminster, B.C.- Last Door Recovery Centre. The Last Door treatment program is a long term treatment program during which individuals are free to come and go (within the program rules) and the addict moves through the intense program at his own pace, including transitioning back into the work force. The program builds a community between those that are facing the same challenges and involves family and friends in the recovery process. Treatment in the Last Door program is individualized to allow each addict to stay clean, one day at a time.

While we are one of the fortunate families that can afford to pay for private treatment, health care, including addictions treatment, should not depend on one’s income, but rather should depend on one’s need. All people struggling with addiction deserve treatment on demand and the ability to find recovery. Their friends, their families and society as a whole will benefit from long term abstinence based treatment and transition being available.

I have written to suggest that Saskatchewan Health increase resources to addictions treatment in Saskatchewan, including:
• More treatment facilities/beds and longer program (minimum of 60 to 90 days);
• Establish transition treatment facilities that allow individuals to transition back into the community and to work, while continuing to have professional and peer support; and
• Treatment on demand being available.

I believe strongly in the right of people dealing with addictions to have treatment available when they are able and willing to seek out help. I support the concept of “treatment on demand.” I am willing to do my part by speaking up and sharing my family’s story. It is time for Saskatchewan to quit being silent about addiction; addiction is rampant and is going to be the biggest health crisis of the decade, if it isn’t already. I urge the Government to take steps to save lives by making long term treatment and transition treatment available in Saskatchewan, so that people can recover, one day at a time.

Canada trails the pack when it comes to mental health funding in comparison to other industrially developed nations. In Saskatchewan specifically, only five percent of the provincial government’s health budget is earmarked for mental health. According to the Saskatchewan Division of the Canadian Mental Health Association, this is two percent less than the Canadian average. Consequently, Saskatchewan is in last place for percentage of health budget allocated to mental health. This directly impacts health regions implementing mental health services, which, in turn, negatively affects the lives of Canadians, often in very serious ways. Specifically, those presenting to emergency room units in mental health crisis often do not get proper care or support. They may even be turned away. This can prove fatal for persons suffering with mental illness. Moreover, the wait time to see a psychiatrist in Saskatchewan is between six months to one year. The wait time to see a psychologist through the Saskatoon Health Region can be up to three months.

Mental health problems cannot be put on a wait list. A person with psychotic break, someone tortured by PTSD, or somebody experiencing debilitating depression or anxiety cannot wait months to see a psychiatrist or psychologist. Mental suffering is far worse than physical suffering, despite it being less visible. Our sense of self is based on our inner experience and the way our mind works. When these become psychotic, confused, or depressed, a person suffers enormously.

Yet, emergency room units often prioritize physical injury over mental pain. Additionally, a healthcare system lacking a separate intake for those in mental, emotional, or spiritual crisis results in special problems. Physical injury competes unfairly with mental illness and those with mental health needs become low priority or even not urgent patients.

We desperately need a transformation of the current system. There needs to be increased funding allocated to mental health within the province. In addition, a separate intake for persons in mental health crisis (including direct access to a psychiatrist) is also needed. For example, in Saskatoon, this could be done at the Dubé Centre. Creating a separate intake would also free up emergency room health care providers to focus solely on physical illness and injury. Now is the time to make emergency mental health support a priority in this province!